Successful cure of a patient with tracheoesophageal fistula in cervical esophageal cancer: A case report and review of literature

BACKGROUND Tracheoesophageal fistula (TEF) is a life-threatening complication of advanced esophageal squamous cell carcinoma (ESCC). Cervical ESCC is rare and frequently diagnosed at an advanced stage. Managing cervical esophageal cancer (CEC) is challenging, requiring intervention by a multidisciplinary team (MDT) and innovative surgical management. CASE SUMMARY Here, we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days, who developed TEF secondary to recurrent ESCC after chemoradiotherapy. He underwent total pharyngolaryngoesophagectomy, left thyroidectomy, and lymphadenectomy. Gastric pull-up was performed to restore gastrointestinal continuity, and a 7 cm × 5 cm supraclavicular artery island flap (SCAIF) was used to reconstruct the lower tracheal defect. Despite severe postoperative complications, he recovered by successful management by a MDT. A 7 cm × 6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect. The patient recovered, regaining the ability to eat and breathe effectively. At the 27-month follow-up, he was alive without recurrence or metastasis. CONCLUSION This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.